title: Internal Hernias and Nonclosure of Mesenteric Defects During Laparoscopic Roux-en-Y Gastric Bypass.
abstract: BACKGROUND
  Internal hernias have been described after laparoscopic Roux-en-Y gastric bypass (LRYGB) as a major problem. Thus, many routinely close defects during LRYGB. In our technique, we do not close any defects. We hypothesize that not closing the defects would not cause a significant internal hernia rate diagnosed during reoperations.
  
  
  METHODS
  Patients who were reoperated after LRYGB were included in this study. Only patients who had a laparoscopic or open exploration focused on inspecting for internal hernias are reported here. The LRYGB technique that was utilized included an antecolic, antegastric gastrojejunostomy, minimal division of the small bowel mesentery, a long jejunojejunostomy performed with three staple lines, adequate division of the omentum, and placement of the jejunojejunostomy above the colon in the left upper quadrant.
  
  
  RESULTS
  There were a total of 387 patients who had LRYGB from 2002 to 2007 utilizing this particular technique. Fifty-four patients had a reoperation at an average of 24 (Range: 1-60) months postoperatively. The procedures were abdominoplasty, cholecystectomy, diagnostic laparoscopy, and lysis of adhesions. While two patients had a defect present, no patient had an internal hernia despite aggressive attempts to diagnose one.
  
  
  CONCLUSIONS
  Internals hernias are not common after our particular method of LRYGB. Before adopting and advocating routine closure, surgeons should consider the surgical technique and the true associated incidence of internal hernias. We do not recommend routine closure of these defects with our technique.
authors.affiliation: Division of Laparoendoscopic and Bariatric Surgery, University of Miami, Miami, FL, USA. atulkmadan@yahoo.com
authors.forename: Atul K
authors.initials: AK
authors.lastname: Madan
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.forename: Naveen
authors.initials: N
authors.lastname: Dhawan
authors.forename: David S
authors.initials: DS
authors.lastname: Tichansky
mesh_terms: D015331:Cohort Studies; D015390:Gastric Bypass / Q000379:methods*; D046449:Hernia, Abdominal / Q000453:epidemiology*; D006801:Humans; D010535:Laparoscopy; D008643:Mesentery / Q000473:pathology / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors